Referrals
Pediatric fever/rash escalation referral checklist
Referral checklist for children with persistent fever/rash when outpatient escalation is needed.
Last reviewed 2026-02-07|pediatrics | fever | rash | triage
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Minimum pre-referral workup
- Full symptom timeline including fever duration, rash progression, and exposure history.
- Vital signs, hydration status, mental status, and documented serial clinical trajectory.
- Immunization status, medication history, and recent travel/contact risk details.
- Focused exam documentation (skin morphology/distribution, mucosal findings, respiratory status).
Urgency tier
- Toxic appearance, altered consciousness, respiratory distress, or poor perfusion.
- Non-blanching/purpuric rash, rapidly progressive rash, or concern for invasive infection.
- Inability to maintain hydration, reduced urine output, or persistent vomiting.
- Clinical deterioration, caregiver inability to monitor safely, or unreliable follow-up access.
Referral packet checklist
- Working differential and reason escalation is needed now versus routine follow-up.
- Key exam findings, vitals trend, and objective deterioration or persistence markers.
- Completed tests/treatments and response to date.
- Explicit safety-net instructions already provided to caregivers.
Pre-referral optimization tasks
- Optimize hydration and fever-care plan, including caregiver dosing understanding.
- Confirm caregivers can recognize warning signs and know where to seek urgent care.
- Arrange short-interval reassessment while referral is pending.